Steffen Lebentrau1, Sven Rauter2, Daniel Baumunk3, Frank Christoph3,4, Frank König3,5, Matthias May6, Martin Schostak3. 1. Department of Urology and Pediatric Urology, Ruppin Clinics, Brandenburg Medical Center and School of Medicine, Fehrbelliner Straße 38, 16816, Neuruppin, Germany. s.lebentrau@ruppiner-kliniken.de. 2. Department of Urology and Pediatric Urology, Ruppin Clinics, Brandenburg Medical Center and School of Medicine, Fehrbelliner Straße 38, 16816, Neuruppin, Germany. 3. Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Str. 44, 39120, Magdeburg, Germany. 4. Urology City West, Joachim-Friedrich-Str. 16, 10711, Berlin, Germany. 5. ATURO Joint Urology Practice, Mecklenburgische Str. 27, 14197, Berlin, Germany. 6. Department of Urology, St. Elisabeth Hospital, St.-Elisabeth-Str. 23, 94315, Straubing, Germany.
Abstract
INTRODUCTION: If technically feasible, organ-preservation is indicated for T1 renal cell carcinoma (RCC), since partial nephrectomy (PN) is equivalent to radical nephrectomy with regard to tumor-specific survival and probably achieves better overall survival. Treatment results of a training clinic were assessed with regard to guideline adherence and treatment quality. METHODS: Based on 220 open interventions in the time periods 2006-2009 (TP1) and 2010-2013 (TP2), a retrospective single center examination was performed to determine the influence of patient-age, sex, BMI, ASA-score, preoperative eGFR, PADUA-score and surgeon's experience on PN-rate and trifecta-outcome (R0 resection, warm ischemia time ≤25 min, no intraoperative complications and no blood-transfusion and postoperative complications grade ≤1 Clavien and Dindo). RESULTS: PN-rate increased from 36.1 % in TP1 to 72.4 % in TP2. Despite significantly higher PADUA-scores in TP2 than in TP1 (p = 0.0038), the trifecta-rate did not differ significantly (TP1 65.7 %; TP2 70.8 %; p = 0.666). Only the PADUA-score exerted an independent influence on the endpoints "organ-preservation" and "trifecta-outcome". CONCLUSIONS: This study again demonstrated that the PADUA-score is a robust predictor of technical feasibility and treatment outcome for open PN. Consistent implementation of guidelines for nephron sparing surgery in RCC ≤7 cm is possible even in the setting of a training clinic and need not be associated with compromised treatment quality despite the increasing level of difficulty. Depending on the author, there are various definitions of trifecta-outcome. A uniform trifecta-concept would be desirable.
INTRODUCTION: If technically feasible, organ-preservation is indicated for T1 renal cell carcinoma (RCC), since partial nephrectomy (PN) is equivalent to radical nephrectomy with regard to tumor-specific survival and probably achieves better overall survival. Treatment results of a training clinic were assessed with regard to guideline adherence and treatment quality. METHODS: Based on 220 open interventions in the time periods 2006-2009 (TP1) and 2010-2013 (TP2), a retrospective single center examination was performed to determine the influence of patient-age, sex, BMI, ASA-score, preoperative eGFR, PADUA-score and surgeon's experience on PN-rate and trifecta-outcome (R0 resection, warm ischemia time ≤25 min, no intraoperative complications and no blood-transfusion and postoperative complications grade ≤1 Clavien and Dindo). RESULTS: PN-rate increased from 36.1 % in TP1 to 72.4 % in TP2. Despite significantly higher PADUA-scores in TP2 than in TP1 (p = 0.0038), the trifecta-rate did not differ significantly (TP1 65.7 %; TP2 70.8 %; p = 0.666). Only the PADUA-score exerted an independent influence on the endpoints "organ-preservation" and "trifecta-outcome". CONCLUSIONS: This study again demonstrated that the PADUA-score is a robust predictor of technical feasibility and treatment outcome for open PN. Consistent implementation of guidelines for nephron sparing surgery in RCC ≤7 cm is possible even in the setting of a training clinic and need not be associated with compromised treatment quality despite the increasing level of difficulty. Depending on the author, there are various definitions of trifecta-outcome. A uniform trifecta-concept would be desirable.
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